scholarly journals Anticipation, teamwork and cognitive load: chasing efficiency during robot-assisted surgery

2017 ◽  
Vol 27 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Kevin Sexton ◽  
Amanda Johnson ◽  
Amanda Gotsch ◽  
Ahmed A Hussein ◽  
Lora Cavuoto ◽  
...  
Keyword(s):  
Cognitive Load ◽  
Operative Time ◽  
Pearson Correlation ◽  
Surgical Team ◽  
Robot Assisted ◽  
Team Members ◽  
Task Load ◽  
Video And Audio ◽  
Team Familiarity ◽  
Robot Assisted Surgery

IntroductionRobot-assisted surgery (RAS) has changed the traditional operating room (OR), occupying more space with equipment and isolating console surgeons away from the patients and their team. We aimed to evaluate how anticipation of surgical steps and familiarity between team members impacted efficiency.MethodsWe analysed recordings (video and audio) of 12 robot-assisted radical prostatectomies. Any requests between surgeon and the team members were documented and classified by personnel, equipment type, mode of communication, level of inconvenience in fulfilling the request and anticipation. Surgical team members completed questionnaires assessing team familiarity and cognitive load (National Aeronautics and Space Administration – Task Load Index). Predictors of team efficiency were assessed using Pearson correlation and stepwise linear regression.Results1330 requests were documented, of which 413 (31%) were anticipated. Anticipation correlated negatively with operative time, resulting in overall 8% reduction of OR time. Team familiarity negatively correlated with inconveniences. Anticipation ratio, per cent of requests that were non-verbal and total request duration were significantly correlated with the console surgeons’ cognitive load (r=0.77, p=0.006; r=0.63, p=0.04; and r=0.70, p=0.02, respectively).ConclusionsAnticipation and active engagement by the surgical team resulted in shorter operative time, and higher familiarity scores were associated with fewer inconveniences. Less anticipation and non-verbal requests were also associated with lower cognitive load for the console surgeon. Training efforts to increase anticipation and team familiarity can improve team efficiency during RAS.

Surgical team: improving teamwork, a review

2019 ◽  
Vol 95 (1124) ◽  
pp. 334-339 ◽  
Author(s):  
Hemant Kumar ◽  
Raimand Morad ◽  
Manish Sonsati
Keyword(s):  
Ad Hoc ◽  
Current System ◽  
Low Cost ◽  
High Yield ◽  
Surgical Team ◽  
Team Members ◽  
Surgical Teams ◽  
The Impact ◽  
Team Familiarity ◽  
Simulated Training

Teams within surgery have been through countless cycles of refinement with an ever-increasing list of surgical team members. This results in a more dispersed team, making effective teamwork harder to achieve. Furthermore, the ad hoc nature of surgical teams means that team familiarity is not always given. The impact of this is seen across the field, with inadequacies leading to disastrous outcomes. This is a review of research that has been done into the topic of surgical teams. It will investigate barriers and consider the evidence available on how to improve the current system. Studies show an increased effectiveness of surgical teams with structures that allowed consistency in team members. The research advocates that advancements made in improving teamwork and efficiency can prove to be a low-cost but high-yield strategy for development. This can be in terms of simulated training, staff turnover management and fixed team allocation.

The Impact of Surgical Team Familiarity on Length of Procedure and Length of Stay: Inconsistent Relationships Across Procedures, Team Members, and Sites

2020 ◽  
Vol 44 (11) ◽  
pp. 3658-3667
Author(s):  
Sarah Henrickson Parker ◽  
Xue Lei ◽  
Shimae Fitzgibbons ◽  
Thomas Metzger ◽  
Shawn Safford ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surgical Team ◽  
Team Members ◽  
The Impact ◽  
Team Familiarity

scholarly journals Surgery Task Load Index in Cardiac Surgery: Measuring Cognitive Load Among Teams

2020 ◽  
pp. 155335062093493
Author(s):  
Lauren R. Kennedy-Metz ◽  
Hill L. Wolfe ◽  
Roger D. Dias ◽  
Steven J. Yule ◽  
Marco A. Zenati
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Load ◽  
Subjective Assessment ◽  
Team Members ◽  
Task Load ◽  
Surgical Complexity ◽  
General Populations ◽  
Nasa Task Load Index ◽  
The Relationship ◽  
Over Time

Background. The most commonly used subjective assessment of perceived cognitive load, the NASA Task Load Index (TLX), has proven valuable in measuring individual load among general populations. The surgery task load index (SURG-TLX) was developed and validated to measure cognitive load specifically among individuals within a surgical team. Notably, the TLX lacks temporal sensitivity in its typical retrospective administration. Objective. This study sought to expand the utility of SURG-TLX by investigating individual measures of cognitive load over time during cardiac surgery, and the relationship between individual and team measures of cognitive load and proxies for surgical complexity. Materials & Methods. SURG-TLX was administered retrospectively in the operating room immediately following each case to approximate cognitive load before, during, and after cardiopulmonary bypass for cardiac surgery team members (surgeon, anesthesiologist, and perfusionist). Correlations were calculated to determine the relationship of individual and team measures of cognitive load over the entire procedure with bypass length and surgery length. Results. Results suggest that perceived cognitive load varies throughout the procedure such that cognitive load during bypass significantly differs compared to before or after bypass, across all 3 roles. While on bypass, results show that anesthesiologists experience significantly lower levels of perceived cognitive load than both surgeons and perfusionists. Correlational analyses reveal that perceived cognitive load of both the surgeon and the team had significant positive associations with bypass length and surgery length. Conclusion. Our findings support the utility of SURG-TLX in real cardiac cases as a measure of cognitive load over time, and on an individual and team-wide basis.

scholarly journals Short-term outcomes in robot-assisted compared to laparoscopic colon cancer resections: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Pedja Cuk ◽  
Mie Dilling Kjær ◽  
Christian Backer Mogensen ◽  
Michael Festersen Nielsen ◽  
Andreas Kristian Pedersen ◽  
...  
Keyword(s):  
Operative Time ◽  
Meta Analysis ◽  
Colon Surgery ◽  
Risk Of Bias ◽  
Robot Assisted ◽  
Short Term ◽  
Level Of Evidence ◽  
Secondary Endpoints ◽  
Laparoscopic Colon ◽  
Robot Assisted Surgery

Abstract Background Robot-assisted surgery is increasingly adopted in colorectal surgery. However, evidence for the implementation of robot-assisted surgery for colon cancer is sparse. This study aims to evaluate the short-term outcomes of robot-assisted colon surgery (RCS) for cancer compared to laparoscopic colon surgery (LCS). Methods Embase, MEDLINE, and Cochrane Library were searched between January 1, 2005 and October 2, 2020. Randomized clinical trials and observational studies were included. Non-original literature was excluded. Primary endpoints were anastomotic leakage rate, conversion to open surgery, operative time, and length of hospital stay. Secondary endpoints were surgical efficacy and postoperative morbidity. We evaluated risk of bias using RoB2 and ROBINS-I quality assessment tools. We performed a pooled analysis of primary and secondary endpoints. Heterogeneity was assessed by I2, and possible causes were explored by sensitivity- and meta-regression analyses. Publication bias was evaluated by Funnel plots and Eggers linear regression test. The level of evidence was assessed by GRADE. Results Twenty studies enrolling 13,799 patients (RCS 1740 (12.6%) and LCS 12,059 (87.4%) were included in the meta-analysis that demonstrated RCS was superior regarding: anastomotic leakage (odds ratio (OR) = 0.54, 95% CI [0.32, 0.94]), conversion (OR = 0.31, 95% CI [0.23, 0.41]), overall complication rate (OR = 0.85, 95% CI [0.73, 1.00]) and time to regular diet (MD =  − 0.29, 95% CI [− 0.56, 0.02]). LCS proved to have a shortened operative time compared to RCS (MD = 42.99, 95% CI [28.37, 57.60]). Level of evidence was very low according to GRADE. Conclusion RCS showed advantages in colonic cancer surgery regarding surgical efficacy and morbidity compared to LCS despite a predominant inclusion of non-RCT with serious risk of bias assessment and a very low level of evidence.

Improving Teamwork: Evaluating Workload of Surgical Team During Robot-assisted Surgery

Urology ◽  
2017 ◽  
Vol 107 ◽  
pp. 120-125 ◽  
Author(s):  
Lora A. Cavuoto ◽  
Ahmed A. Hussein ◽  
Vivek Vasan ◽  
Youssef Ahmed ◽  
Ayesha Durrani ◽  
...  
Keyword(s):  
Surgical Team ◽  
Robot Assisted ◽  
Robot Assisted Surgery

scholarly journals Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028635 ◽  
Author(s):  
Rebecca Randell ◽  
Stephanie Honey ◽  
Natasha Alvarado ◽  
Joanne Greenhalgh ◽  
Jon Hindmarsh ◽  
...  
Keyword(s):  
Interview Study ◽  
Routine Practice ◽  
Team Leaders ◽  
Robot Assisted ◽  
Team Members ◽  
Initial Decision ◽  
Surgical Trainees ◽  
Theatre Staff ◽  
Operation Duration ◽  
Robot Assisted Surgery

ObjectiveTo capture stakeholders’ theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice.DesignA literature review provided tentative theories that were revised through a realist interview study. Literature-based theories were presented to the interviewees, who were asked to describe to what extent and in what ways those theories reflected their experience. Analysis focused on identifying mechanisms through which robot-assisted surgery becomes integrated into practice and contexts in which those mechanisms are triggered.SettingNine hospitals in England where robot-assisted surgery is used for colorectal operations.ParticipantsForty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists.ResultsInterviewees emphasised the importance of support from hospital management, team leaders and surgical colleagues. Training together as a team was seen as beneficial, increasing trust in each other’s knowledge and supporting team bonding, in turn leading to improved teamwork. When first introducing robot-assisted surgery, it is beneficial to have a handpicked dedicated robotic team who are able to quickly gain experience and confidence. A suitably sized operating theatre can reduce operation duration and the risk of de-sterilisation. Motivation among team members to persist with robot-assisted surgery can be achieved without involvement in the initial decision to purchase a robot, but training that enables team members to feel confident as they take on the new tasks is essential.ConclusionsWe captured accounts of how robot-assisted surgery has been introduced into a range of hospitals. Using a realist approach, we were also able to capture perceptions of the factors that support and constrain the integration of robot-assisted surgery into routine practice. We have translated these into recommendations that can inform future implementations of robot-assisted surgery.

Correlating Physiologic Measures of Stress: Exploring Dyads in Clinical Surgical Teams

2020 ◽  
Vol 64 (1) ◽  
pp. 702-706
Author(s):  
Allan Fong ◽  
Shimae Fitzgibbons ◽  
Jack Sava ◽  
Weiguang Wang ◽  
Nicholas R. Wegener ◽  
...  
Keyword(s):  
Pulse Wave ◽  
Pearson Correlation ◽  
Temporal Correlation ◽  
Surgical Team ◽  
High Stakes ◽  
Current Form ◽  
Team Members ◽  
Surgical Teams ◽  
Overlap Method ◽  
Physiologic Data

Clinical teams are subject to stress from various sources, including the technical and cognitive challenges of providing care in high stakes environments. Existing analytic approaches are limited in their ability to study the interdependence of team member stress. This study explores the correlation of a physiologic marker of stress, blood pulse wave, between members of a working surgical team. We propose an area overlap method as a means of evaluating blood pulse wave time-series correlation as a function of time. This is a stepwise approach to the collection and analysis of a large volume of continuous physiologic data from paired team members in a clinical setting. This method was applied to thirteen surgical team dyads with similar results to Pearson correlation. The area overlap method allows for improved exploration of temporal correlation within dyads but, in its current form, does not identify directionality of correlation.

Do not break up the surgical team! Familiarity and expertise affect operative time in complex surgery

2018 ◽  
Vol 215 (3) ◽  
pp. 447-449 ◽  
Author(s):  
Eric J. Finnesgard ◽  
T.K. Pandian ◽  
Michael L. Kendrick ◽  
David R. Farley
Keyword(s):  
Operative Time ◽  
Surgical Team ◽  
Break Up ◽  
Team Familiarity ◽  
Complex Surgery

scholarly journals “Put the what, where? Cut here?!” challenges to coordinating attention in robot-assisted surgery: a microanalytic pilot study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046132
Author(s):  
Antara Satchidanand ◽  
Jeff Higginbotham ◽  
Ann Bisantz ◽  
Naif Aldhaam ◽  
Ahmed Elsayed ◽  
...  
Keyword(s):  
Pilot Study ◽  
Effective Means ◽  
Relative Timing ◽  
Robot Assisted ◽  
Functional Movement ◽  
Team Members ◽  
Environmental Support ◽  
Communicative Efficiency ◽  
Insight Into ◽  
Robot Assisted Surgery

IntroductionDuring robot-assisted surgery (RAS), changes to the operating room configuration pose challenges to communication by limiting team members’ ability to see one another or use gesture. Referencing (the act of pointing out an object or area in order to coordinate action around it), may be susceptible to miscommunication due to these constraints.ObjectivesExplore the use of microanalysis to describe and evaluate communicative efficiency in RAS through examination of referencing in surgical tasks.MethodsAll communications during ten robot-assisted pelvic surgeries (radical cystectomies and prostatectomies) were fully transcribed. Forty-six referencing events were identified within these and subjected to a process of microanalysis. Microanalysis employs detailed transcription of speech and gesture along with their relative timing/sequencing to describe and analyse interactions. A descriptive taxonomy for referencing strategies was developed with categories including references reliant exclusively on speech (anatomic terms/directional language and context dependent words (CD)); references reliant exclusively on gesture or available aspects of the environment (point/show, camera focus/movement in the visual field and functional movement); and references reliant on the integrated use of speech and gesture/environmental support (integrated communication (IC)). Frequency of utilisation and number/percent ‘miscommunication’, were collated within each category when miscommunication was defined as any reference met with incorrect or no identification of the target.ResultsIC and CD were the most frequently used strategies (45% and 26%, respectively, p≤0.01). Miscommunication was encountered in 22% of references. The use of IC resulted in the fewest miscommunications, while CD was associated with the most miscommunications (42%). Microanalysis provided insight into the causes and nature of successful referencing and miscommunication.ConclusionsIn RAS, surgeons complete referencing tasks in a variety of ways. IC may provide an effective means of referencing, while other strategies may not be adequately supported by the environment.

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